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Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.

Methods

A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence.

Results

An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working.

Conclusions

We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

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Acknowledgements

The authors are grateful to the experts who contributed to this project.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 4AT, UK

    Nader K. Francis & Thomas Walker

  2. Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK

    Nader K. Francis

  3. South West Surgical Training Network, ERAS-UK, Yeovil, Somerset, BA20 2RH, UK

    Fiona Carter

  4. Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland

    Martin Hübner, Nicolas Demartines & Valerie Addor

  5. NHS Lothian Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland

    Angela Balfour

  6. Section of Surgical Pathophysiology 4074, Rigshospitalet, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark

    Dorthe Hjort Jakobsen

  7. Head of Gastrointestinal Nurse Education, Academic Institute, St Mark’s Hospital, London, HA1 3UJ, UK

    Jennie Burch

  8. Strategic Clinical Networks, Alberta Health Services, Edmonton, AB, Canada

    Tracy Wasylak

  9. Faculty of Nursing, University of Calgary, 10301 Southport Lane SW, Calgary, AB, T2W1S7, Canada

    Tracy Wasylak

  10. Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH, UK

    Dileep N. Lobo

  11. Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 85, Orebro, Sweden

    Olle Ljungqvist

Authors
  1. Nader K. Francis
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  2. Thomas Walker
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  3. Fiona Carter
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  4. Martin Hübner
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  5. Angela Balfour
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  6. Dorthe Hjort Jakobsen
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  7. Jennie Burch
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  8. Tracy Wasylak
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  9. Nicolas Demartines
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  10. Dileep N. Lobo
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  11. Valerie Addor
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  12. Olle Ljungqvist
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Corresponding author

Correspondence to Nader K. Francis.

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Francis, N.K., Walker, T., Carter, F. et al. Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study. World J Surg 42, 1919–1928 (2018). https://doi.org/10.1007/s00268-017-4436-2

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  • DOI: https://doi.org/10.1007/s00268-017-4436-2

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